SBIRT Training will be delivered and adapted to the unique needs and schedule demands of each residency program. SBIRT training can be delivered in a 1.5 – 3 hour training to a group of residents or conducted in a one on one setting over the course a month long addiction medicine or behavioral medicine rotation. This training includes the use of training videos and role play to maximize the direct observation and practice of SBIRT skills.

SBIRT training covers the following areas:

SCREENING & ASSESSMENT: An overview of tools used to identify the full spectrum of risky, problematic substance use, abuse and dependence. Many standardized screening and assessment tools have been developed for use in various medical settings (CAGE, AUDIT, Alcohol Quantity/frequency/heavy drinking questions, DAST, CRAFFT). Residents will become more comfortable with the use of these basic tools in various practice settings and learn different ways of incorporating screening into their practice.

BRIEF INTERVENTIONS & EFFECTIVE REFERRAL TO TREATMENT: An overview of brief intervention procedures and evidence of their effectiveness. The literature that supports the efficacy of brief interventions in behavior change for for alcohol, tobacco and substance misuse as well as other problematic behaviors specific to that residency program (such as diet, risky sexual behaviors, and exercise) is outlined. Addresses how brief intervention interacts with the process of change and the key elements that are thought to be important components of effectiveness of these interventions (Miller’s FRAMES, teachable moments, opportunistic interventions) identified in the literature. Brief doctor-patient communication styles and strategies are addressed, including a large practice component to develop the skills that would be used in the brief intervention part of the protocol. This section aims for a the motivational interviewing and enhancing style of communication to be viewed as helpful in general practice as well as in this protocol since there is increasing evidence of the value of patient centered communication in medical practice. This section also addresses the “5A’s” of assessing severity and motivation; give a clear message of advice, offer options and a referral if needed, and link to treatment. Exemplars are used both as an individual physician model as well as a group practice model in order to make sure that the residents see the relevance and feasibility of the SBIRT protocol in various types of practice settings.

TREATMENT: Overview of various treatments for substance use disorders, including psychosocial treatments, medications and the integration of pharmacotherapy with psychosocial treatments. Out-patient and residential programs as well as 12-step, mutual help groups are discussed. An overview of the ASAM patient-placement criteria is provided and the residents are educated on web-based resources through the Maryland Alcohol and Drug Abuse Administration (ADAA) so that they can link patients to specialty treatment service providers and facilities.